crest syndrome

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="04a00840erlcjm.png"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>usmle medecine part 2</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="usmle medecine part 2"><U><B>home</B></U></A></div> <div> <B>crest syndrome</B>   |   <A HREF="id20.htm" TARGET="_top" TITLE="raynauld phenomenon"><U>raynauld phenomenon</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="scleroderma"><U>scleroderma</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="The Iliac Crest Syndrome"><U>The Iliac Crest Syndrome</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="cardio"><U>cardio</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="hypoparathyroidism"><U>hypoparathyroidism</U></A>   |   <A HREF="id25.htm" TARGET="_top" 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Syndrome</B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="cardio"><U><B>cardio</B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="hypoparathyroidism"><U><B>hypoparathyroidism</B></U></A></div> <div> <A HREF="id25.htm" TARGET="_top" TITLE="hypercalcemia"><U><B>hypercalcemia</B></U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="hyperphosphatemia"><U><B>hyperphosphatemia</B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="leukemia"><U><B>leukemia</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="glossary"><U><B>glossary</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A></div> <div> <B> <img src="HTMLobj-145/aniGif.gif" border="0" align="bottom" width="72" height="144">  </B></div> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> crest syndrome</div> <div> CREST<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT>syndrome</div> <bR> <div> seen in connective tissue diseases, including: </div> <div> <U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">scleroderma</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > ("progressive systemic sclerosis", PSS) </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">dermatomyositis </div> <div> <B>C </B></div> <div> <B>calcinosis cutis </B></div> <div> <B>R </B></div> <div> <B>Raynaud's phenomenon </B></div> <div> <B>E </B></div> <div> <B>esophageal dysmotility</B><B> </B></div> <div> <B>S </B></div> <div> <B>scleroderma </B></div> <div> <B>T </B></div> <div> <B>telangiectasias </B></div> <bR> <div> The <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> form of scleroderma tends to be confined to the skin of the fingers and face. </div> <div> The skin changes and other features of disease tend to occur more slowly than in the diffuse form. </div> <div> A characteristic clinical pattern can occur in patients with the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> form of scleroderma. </div> <div> This name represents the following features:[see above ]</div> <bR> <div> <B>C</B>.....Calcinosis, refers to the formation of tiny deposits of calcium in the skin. </div> <div> This is seen as hard whitish areas in the superficial skin, </div> <div> commonly overlying</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> the elbows, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">knees, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">or fingers. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">These firm deposits can be tender, can become infected, and can fall off spontaneously or require surgical removal.</div> <div> <IMG SRC="05b1a540.jpg" border=0 width="282" height="340" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="05dbbec0.jpg" border=0 width="187" height="236" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>R</B>.....Raynauds phenomenon refers to the spasm of the tiny artery vessels supplying blood to </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">the fingers, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">toes, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">nose,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> tongue,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> or ears.</div> <div> <B> These areas turns blue, white, then red after exposure to extremes of cold, or even sometimes with extremes of heat or emotional upset. </B></div> <div> <IMG SRC="05f43a50.jpg" border=0 width="323" height="165" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0617d020.jpg" border=0 width="381" height="258" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>E</B>.....Esophagus disease in scleroderma is characterized by poorly functioning muscle of the lower 2/3 of the esophagus. </div> <div> This can lead to an abnormally wide esophagus which allows stomach acid to backflow into the esophagus to cause heartburn, inflammation, and potentially scarring. </div> <div> This can eventually lead to difficulty in passing food from the mouth through the esophagus into the stomach[dysphagia].</div> <div>  Symptoms of heartburn are treated aggressively in patients with scleroderma in order to prevent injury to the esophagus.</div> <bR> <div> <B>S</B>.....Sclerodactyly refers to the localized thickening and tightness of the skin of the fingers or toes.</div> <div>  This can give them a "shiny" appearance. </div> <div> The tightness can cause severe limitation of motion of the fingers and toes.</div> <div>  These skin changes generally progress much slower that those of patients with the diffuse form of scleroderma.</div> <bR> <div> <B>T</B>.....Telangiectasia are tiny red areas, </div> <div> frequently on </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">the face,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> hands </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and in the mouth behind the lips. </div> <bR> <div> These areas blanch when they are pressed upon and represent dilated capillaries. </div> <bR> <bR> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Patients can have variations of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT>, i.e. CRST, REST, ST, etc. Patients can also have "overlap" illness with features of both <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> and the diffuse form of scleroderma. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Some patients have overlaps of scleroderma and other connective tissue diseases, such as </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">rheumatoid arthritis, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">systemic lupus erythematosus, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and polymyositis. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Approximately 10 percent of patients with the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> variant develop<B><U> elevated pressures in the blood vessels to the lungs (pulmonary hypertension).</U></B></div> <bR> <div> <B><U>It takes only two of the five </U></B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B><U>CREST</U></B></FONT><B><U> symptoms for a diagnosis of </U></B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B><U>CREST</U></B></FONT><B><U> (either “pure” or “plus”) to be made.</U></B></div> <div> For example, a patient with Calcinosis and Raynaud’s would have <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> (which for precision may also be written as <FONT SIZE="3" COLOR="#800000" FACE="Arial" >Crest</FONT>, but it is <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> nonetheless.)</div> <bR> <bR> <div> a kind of classification according to the criterias found:</div> <DIV ALIGN="LEFT"></DIV> <div>  <A NAME="purecrest"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Pure </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>CREST</B></FONT></div> <div> “Pure”<FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> — by itself: “Pure” <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> is diagnosed when patients have two or more symptoms of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> but they do not meet the criteria for either Limited or Diffuse Scleroderma. </div> <div> That is, they must not have tight skin above their wrists, and if there is tight skin on their fingers, they must not have either pitting digital ulcers or lung fibrosis </div> <bR> <DIV ALIGN="LEFT"></DIV> <div>  <A NAME="pluscrest"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Plus </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>CREST</B></FONT></div> <div> "Plus” <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> — along with: When <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> symptoms appear along with another form of Scleroderma, it is referred to as, for example, “Limited Scleroderma plus <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT>” or “Diffuse Scleroderma plus <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT>.” A person may also have any other autoimmune disease “plus <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT>.” </div> <bR> <DIV ALIGN="LEFT"></DIV> <div>  <A NAME="crestprogression"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Progression of </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>CREST</B></FONT></div> <div> Although some doctors still believe <FONT SIZE="3" COLOR="#800000" FACE="Arial" >CREST</FONT> is a subcategory, the existing research studies have been unable to predict consistently how (or whether) the disease will progress to Diffuse Systemic Scleroderma in any specific individual. </div> <bR> <bR> <bR> </td> </tr></table></body>